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A bill signed into law by President Barack Obama takes the first step toward offering dental benefits to all 23 million U.S. veterans and also veterans' dependents and survivors.
“The legislation is very positive, but it is simply too early to comment beyond that.”
— Joe Davis, Veterans of Foreign Wars
The Caregivers and Veterans Omnibus Health Services Act, signed May 5 by Obama, directs the Department of Veterans Affairs (VA) to undertake a feasibility study on selling dental insurance to these groups.
The law is vague on specifics, with much left to the VA to decide. "The legislation is very positive, but it is simply too early to comment beyond that," said Joe Davis, a spokesman for the Veterans of Foreign Wars (VFW).
The insurance program will be voluntary, and the VA "will contract with a dental insurer" to administer the plan, charging premiums high enough to cover its cost.
VA spokesman Drew Brookie said he had no information yet beyond the text of the bill itself, which leaves unclear such key questions as where the pilot program will take place and how patients and providers can sign up.
Covered benefits will include at minimum diagnostic, preventive, endodontic, and other restorative services, as well as surgical and emergency services.
Currently, veterans are only eligible for dental benefits under one of the following circumstances: their dental needs result from their military service, their dental needs affect a covered medical condition, they are disabled or unemployable because of their service, or they are homeless or in rehabilitation. The VA directly employs a team of dentists. The new law specifically leaves these programs in place.
Under the terms of the new law, the pilot dental insurance program will start some time in the next 267 days and will last three years.
The pilot program is part of a larger package of health benefits offered to veterans under the new law. The law offers expanded healthcare for female veterans, such as maternity care for newborn children. It eliminates co-payments for badly disabled veterans, expands homeless support, and extends benefits to people who care for veterans.
"We're forever mindful that our obligations to our troops don't end on the battlefield," said Obama in signing the bill. "Just as we have a responsibility to train and equip them when we send them into harm's way, we have a responsibility to take care of them when they come home."
Sunday, May 16, 2010
Oral health declining in the U.S.
In a recent story on dental health aid therapists, the New York Times noted that "a study last year from the Centers for Disease Control [sic] showed that Americans' dental health was worsening for the first time since statistics began to be kept."
But the gloomy pronouncement may be in error. Last year, the Centers for Disease Control and Prevention (CDC) released its annual report on U.S. health, "Health, United States, 2007." The report had some dismal numbers on access to care, but it noted that the oral health of the nation has improved in recent times.
"Between 1988–1994 and 2001–2004, approximately one-quarter of adults 20–64 years of age had untreated dental caries, down from nearly one-half in 1971–1974," the report noted.
Another CDC report released in April 2007 -- "Trends in Oral Health Status: United States, 1988–1994 and 1999–2004" -- noted that "for most Americans, oral health status has improved since 1988–1994." Both reports relied for oral health statistics primarily on the National Health and Nutrition Examination Survey, for which 2004 statistics are the most recently available.
The second CDC report also noted that since the early 1970s dental caries levels have declined significantly among school-aged children, fewer adults have experienced tooth loss because of dental decay or periodontal disease, and complete tooth loss among adults has consistently declined.
But even though the oral health of the nation has improved, "oral health disparities remain across some population groups."
But the gloomy pronouncement may be in error. Last year, the Centers for Disease Control and Prevention (CDC) released its annual report on U.S. health, "Health, United States, 2007." The report had some dismal numbers on access to care, but it noted that the oral health of the nation has improved in recent times.
"Between 1988–1994 and 2001–2004, approximately one-quarter of adults 20–64 years of age had untreated dental caries, down from nearly one-half in 1971–1974," the report noted.
Another CDC report released in April 2007 -- "Trends in Oral Health Status: United States, 1988–1994 and 1999–2004" -- noted that "for most Americans, oral health status has improved since 1988–1994." Both reports relied for oral health statistics primarily on the National Health and Nutrition Examination Survey, for which 2004 statistics are the most recently available.
The second CDC report also noted that since the early 1970s dental caries levels have declined significantly among school-aged children, fewer adults have experienced tooth loss because of dental decay or periodontal disease, and complete tooth loss among adults has consistently declined.
But even though the oral health of the nation has improved, "oral health disparities remain across some population groups."
Mouthwash facts
Most of us have a bottle of mouthwash in our medicine cabinets or on our bathroom counter. Maybe you use yours everyday or simply keep it around for those times when you need a quick breath freshener without having to pick up your toothbrush. Although the common belief is that mouthwash kills bad breath, experts have conflicting arguments about the benefits of mouthwash, or lack thereof. It's time to sort through the evidence and learn the truth about mouthwash once and for all.
Do You Know Your Mouthwash?
There are two schools of thought when it comes to formulating mouthwash. One style contains a high percentage of alcohol. For example, Listerine contains 26.9% alcohol, which is 5 times more than most beers and twice as much as wine.
Contrary to popular belief, the alcohol in such mouthwashes does not kill the bacteria responsible for bad breath. Rather, the alcohol is used as a carrier of essential oils, which are the active ingredients in the formula. In the case of Listerine, eucalyptol, menthol, methyl salicylate and thymol dissolve in the alcohol so they can reach your gums and effectively target plaque.
The problem with alcohol-based mouthwashes, argue some critics, is that alcohol is known to dry out the mouth. People with dry mouth are more prone to bad breath because they do not have enough saliva available to naturally wash away the bacteria, which release mouth odors. While dry mouth seems like a valid concern, members of the American Dental Association have noted that alcohol-containing mouthwashes do not exacerbate bad breath.
Research supports this claim. One study showed that people who already suffered from dry mouth who rinsed with Listerine threes times a day did not experience any additional dryness.
There may, however, be a more pressing problem with alcohol-based products. They can be a danger to children, who may be curious enough to drink such products. If there are children in your home, you might consider using an alcohol-free mouthwash, such as Crest Pro-Health.
Do They Really Work?
Regardless of what formula you choose, the question about mouthwash remains: Do they really work?
It is estimated that 25% of Americans suffer from chronic bad breath. While Listerine and various other products may be effective for preventing conditions like gingivitis, they do not kill bacteria in the mouth. Bad breath is the result of sulfur compounds released by bacteria. Everyone collects bacteria throughout the day. People with cavities or swollen gums have an additional challenge, however, because there is more damaged tissue where bacteria can grow. Studies have demonstrated that ingredients chlorine dioxide and zinc are effective at neutralizing some mouth odors.
To fight bad breath at its source, you need to get rid of bacteria. Unfortunately, mouthwash alone will not accomplish that goal. Experts suggest that twice or even three times daily brushing and flossing is the best defense against bacteria. Using a tongue scraper to remove additional bacteria is highly effective for many people with chronic bad breath. When you brush, floss or scrape, you are physically removing the odor-causing bacteria. Mouthwash may promote healthy gums and provide a fresh clean feeling, but it does not eliminate bacteria.
The final verdict?
If you enjoy using mouthwash in addition to regular brushing and flossing, there is no need to change your routine. If you are struggling with bad breath, you should focus your efforts on physically removing bacteria by brushing, flossing and any other solutions recommended by your dentist. Mouthwash can indeed mask and even neutralize unpleasant odors, but it will not solve the problem on its own.
Do You Know Your Mouthwash?
There are two schools of thought when it comes to formulating mouthwash. One style contains a high percentage of alcohol. For example, Listerine contains 26.9% alcohol, which is 5 times more than most beers and twice as much as wine.
Contrary to popular belief, the alcohol in such mouthwashes does not kill the bacteria responsible for bad breath. Rather, the alcohol is used as a carrier of essential oils, which are the active ingredients in the formula. In the case of Listerine, eucalyptol, menthol, methyl salicylate and thymol dissolve in the alcohol so they can reach your gums and effectively target plaque.
The problem with alcohol-based mouthwashes, argue some critics, is that alcohol is known to dry out the mouth. People with dry mouth are more prone to bad breath because they do not have enough saliva available to naturally wash away the bacteria, which release mouth odors. While dry mouth seems like a valid concern, members of the American Dental Association have noted that alcohol-containing mouthwashes do not exacerbate bad breath.
Research supports this claim. One study showed that people who already suffered from dry mouth who rinsed with Listerine threes times a day did not experience any additional dryness.
There may, however, be a more pressing problem with alcohol-based products. They can be a danger to children, who may be curious enough to drink such products. If there are children in your home, you might consider using an alcohol-free mouthwash, such as Crest Pro-Health.
Do They Really Work?
Regardless of what formula you choose, the question about mouthwash remains: Do they really work?
It is estimated that 25% of Americans suffer from chronic bad breath. While Listerine and various other products may be effective for preventing conditions like gingivitis, they do not kill bacteria in the mouth. Bad breath is the result of sulfur compounds released by bacteria. Everyone collects bacteria throughout the day. People with cavities or swollen gums have an additional challenge, however, because there is more damaged tissue where bacteria can grow. Studies have demonstrated that ingredients chlorine dioxide and zinc are effective at neutralizing some mouth odors.
To fight bad breath at its source, you need to get rid of bacteria. Unfortunately, mouthwash alone will not accomplish that goal. Experts suggest that twice or even three times daily brushing and flossing is the best defense against bacteria. Using a tongue scraper to remove additional bacteria is highly effective for many people with chronic bad breath. When you brush, floss or scrape, you are physically removing the odor-causing bacteria. Mouthwash may promote healthy gums and provide a fresh clean feeling, but it does not eliminate bacteria.
The final verdict?
If you enjoy using mouthwash in addition to regular brushing and flossing, there is no need to change your routine. If you are struggling with bad breath, you should focus your efforts on physically removing bacteria by brushing, flossing and any other solutions recommended by your dentist. Mouthwash can indeed mask and even neutralize unpleasant odors, but it will not solve the problem on its own.
Preventing and controlling diabetes
The American Diabetes Association feels so strongly about the link between periodontal disease and type 2 diabetes that the group invited a number of dentists to share their thoughts on this growing problem during a special symposium at the 68th annual meeting of the American Diabetes Association this week in San Francisco.
According to the American Dental Association, nearly 10% (21 million) of the U.S. population has diabetes, which means U.S. dentists can expect to have more than 120 diabetic patient visits per year. Some 5% of diabetic patients are type 1, while the other 95% are type 2 -- the form that develops in adulthood and is linked to excess weight and a sedentary lifestyle.
Dental disease and the associated inflammation is an early warning sign of diabetes and its complications. In addition, diabetics with periodontal disease have a harder time controlling blood sugar levels.
"One of the many complications of diabetes is a greater risk for periodontal disease," said Maria E. Ryan, D.D.S., Ph.D., a professor of oral biology and pathology at Stony Brook University, New York, at the diabetes association dental symposium. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels."
A key finding to be reported at the diabetes meeting was the fact that in prediabetic patients -- those who are insulin-resistant but are not yet presenting with the disease -- the level of oral disease seems to correlate with the insulin resistance, she added.
"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," Dr. Ryan said at the meeting.
Recent studies have also shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death, according to George W. Taylor, Dr.P.H., D.M.D., an associate professor of dentistry at the University of Michigan.
What dentists can do:
While patients with well-controlled diabetes can often be treated in similar ways as nondiabetic patients, diabetic patients often do have special needs.
The American Dental Association offers these tips for working with diabetic patients:
• Emphasize soft-tissue management to help avoid infections.
• Establish a more frequent recall schedule if indicated -- three to four months rather than six to 12 months.
• Emphasize proper home care, including brushing twice a day, flossing daily, and possibly using plaque-reducing toothpaste and mouthwash to help control gingivitis.
• For nonsurgical procedures such as periodontal debridement, restorations, orthodontic adjustments, fluoride treatments, and intraoral x-rays, try to schedule morning appointments and offer regular bathroom and snack breaks.
• For surgical procedures such as extractions and implants, try to schedule morning appointments and treatment breaks. Also consider systemic antibiotics for patients who have frequent infections or heal poorly. Consult with the patient or his or her physician about meal schedules and timing/dosage of insulin.
He pointed to an analysis of the National Health and Nutrition Examination Survey of the U.S. population data between 1988 and 1994, in which he and his colleagues found that people with periodontal disease were twice as likely to be insulin-resistant than those without such disease. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, and whether they had diabetes.
Dr. Taylor also reported on studies at the University of Michigan and elsewhere that further demonstrate the association between periodontitis and the complications of type 2 diabetes.
"Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," Dr. Taylor said.
For example, a recent set of observational studies of southwestern U.S. Pima Indians, a population with a very high rate of type 2 diabetes, investigated whether those with periodontitis are more likely to develop poorer glycemic control. Dr. Taylor noted that those with periodontitis were more than four times as likely to develop worsened glycemic control after two years of follow-up.
Dr. Ryan recommends that the medical and dental communities work together to play a more proactive and preventive role in treating diabetic patients. In addition to checking for bleeding gums and other signs of gingivitis, if a patient's glycemia has been difficult to control, the physician should ask when the patient last visited a dentist, whether periodontitis has been diagnosed, and, if so, whether treatment has been completed. A consultation with the dentist might then be appropriate to discuss whether periodontal treatment has been successful or if a more intensive approach with oral or subantimicrobial antibiotics is in order.
"Just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums," she said. "Diabetes educators and healthcare providers need to be informed of this and refer their patients to dentists for evaluation," she noted in an interview with DrBicuspid.com.
In addition to helping diabetic patients manage their disease through better oral health and regular checkups, dental care providers can also play an important role in helping to diagnose patients whose diabetes has not yet been detected, Dr. Ryan added.
"The Centers for Disease Control estimates that 40% of people with diabetes don't know they have it," she said. "And certainly dental care providers are in a position to help identify people at risk of diabetes. We know that periodontal disease leads to heightened levels of C-reactive proteins, and studies are now showing that people with elevated C-reactive protein levels are the most likely to convert to diabetes within five years. But if you treat the periodontal disease, you can reduce the levels of A1C. Now we need to find out if treating periodontal disease will delay the onset of diabetes, and this we don't know yet."
According to the American Dental Association, nearly 10% (21 million) of the U.S. population has diabetes, which means U.S. dentists can expect to have more than 120 diabetic patient visits per year. Some 5% of diabetic patients are type 1, while the other 95% are type 2 -- the form that develops in adulthood and is linked to excess weight and a sedentary lifestyle.
Dental disease and the associated inflammation is an early warning sign of diabetes and its complications. In addition, diabetics with periodontal disease have a harder time controlling blood sugar levels.
"One of the many complications of diabetes is a greater risk for periodontal disease," said Maria E. Ryan, D.D.S., Ph.D., a professor of oral biology and pathology at Stony Brook University, New York, at the diabetes association dental symposium. "If you have this oral infection and inflammation, as with any infection, it's much more difficult to control blood glucose levels."
A key finding to be reported at the diabetes meeting was the fact that in prediabetic patients -- those who are insulin-resistant but are not yet presenting with the disease -- the level of oral disease seems to correlate with the insulin resistance, she added.
"We have found evidence that the severity of periodontal disease is associated with higher levels of insulin resistance, often a precursor of type 2 diabetes, as well as with higher levels of A1C, a measure of poor glycemic control of diabetes," Dr. Ryan said at the meeting.
Recent studies have also shown that having periodontal disease makes those with type 2 diabetes more likely to develop worsened glycemic control and puts them at much greater risk of end-stage kidney disease and death, according to George W. Taylor, Dr.P.H., D.M.D., an associate professor of dentistry at the University of Michigan.
What dentists can do:
While patients with well-controlled diabetes can often be treated in similar ways as nondiabetic patients, diabetic patients often do have special needs.
The American Dental Association offers these tips for working with diabetic patients:
• Emphasize soft-tissue management to help avoid infections.
• Establish a more frequent recall schedule if indicated -- three to four months rather than six to 12 months.
• Emphasize proper home care, including brushing twice a day, flossing daily, and possibly using plaque-reducing toothpaste and mouthwash to help control gingivitis.
• For nonsurgical procedures such as periodontal debridement, restorations, orthodontic adjustments, fluoride treatments, and intraoral x-rays, try to schedule morning appointments and offer regular bathroom and snack breaks.
• For surgical procedures such as extractions and implants, try to schedule morning appointments and treatment breaks. Also consider systemic antibiotics for patients who have frequent infections or heal poorly. Consult with the patient or his or her physician about meal schedules and timing/dosage of insulin.
He pointed to an analysis of the National Health and Nutrition Examination Survey of the U.S. population data between 1988 and 1994, in which he and his colleagues found that people with periodontal disease were twice as likely to be insulin-resistant than those without such disease. This result was found after controlling for other characteristics that would be associated with insulin resistance, such as obesity, lipids, exercise, and other markers of inflammation, and whether they had diabetes.
Dr. Taylor also reported on studies at the University of Michigan and elsewhere that further demonstrate the association between periodontitis and the complications of type 2 diabetes.
"Given the numerous medical studies showing that good glycemic control results in reduced development and progression of diabetes complications, we believe there is the potential that periodontal treatment can provide an increment in diabetes control and subsequently a reduction in the risk for diabetes complications," Dr. Taylor said.
For example, a recent set of observational studies of southwestern U.S. Pima Indians, a population with a very high rate of type 2 diabetes, investigated whether those with periodontitis are more likely to develop poorer glycemic control. Dr. Taylor noted that those with periodontitis were more than four times as likely to develop worsened glycemic control after two years of follow-up.
Dr. Ryan recommends that the medical and dental communities work together to play a more proactive and preventive role in treating diabetic patients. In addition to checking for bleeding gums and other signs of gingivitis, if a patient's glycemia has been difficult to control, the physician should ask when the patient last visited a dentist, whether periodontitis has been diagnosed, and, if so, whether treatment has been completed. A consultation with the dentist might then be appropriate to discuss whether periodontal treatment has been successful or if a more intensive approach with oral or subantimicrobial antibiotics is in order.
"Just as it is difficult to control diabetes while the patient has an infected leg ulcer, the same applies when there's infection and inflammation of the gums," she said. "Diabetes educators and healthcare providers need to be informed of this and refer their patients to dentists for evaluation," she noted in an interview with DrBicuspid.com.
In addition to helping diabetic patients manage their disease through better oral health and regular checkups, dental care providers can also play an important role in helping to diagnose patients whose diabetes has not yet been detected, Dr. Ryan added.
"The Centers for Disease Control estimates that 40% of people with diabetes don't know they have it," she said. "And certainly dental care providers are in a position to help identify people at risk of diabetes. We know that periodontal disease leads to heightened levels of C-reactive proteins, and studies are now showing that people with elevated C-reactive protein levels are the most likely to convert to diabetes within five years. But if you treat the periodontal disease, you can reduce the levels of A1C. Now we need to find out if treating periodontal disease will delay the onset of diabetes, and this we don't know yet."
Elderly have barriers to proper dental care
An inability to pay for treatment, lack of transport to the dental office, and lack of perceived need are some of the biggest barriers to dental care for elderly patients, according to a new ADA survey.
The ADA Survey Center conducted the survey on behalf of the Council on Access, Prevention, and Interprofessional Relations in response to a resolution that called for initiatives related to the oral health of vulnerable elders, according to an ADA news article.
"As we learn more about the oral-systemic relationship of disease, and as our population ages, we as a council are increasingly concerned about the quality of life faced by those elderly who have dental needs and little or no ability to have them addressed," stated Jerald Boseman, D.D.S., a council member from Salt Lake City, in the article.
Other results from the survey include:
• In 2007, more than 92% of all dentists provided care to the vulnerable elderly -- patients who are over age 65 and have limited mobility, limited resources, or complex health status.
• More than 24% required dentists to consult with dental specialists, and more than 37% required dentists to consult with physicians.
• More than 68% of dentists said that they needed more information on managing patients with complex medical histories, managing xerostomia (63.6%), and managing dementia patients (49.1%).
• Some of the major barriers to care reported by the dentists included inability to pay for services (88.7%), lack of transportation to dentist's office (68.4%), inadequate financial support for care from local, state, and/or federal programs (65.5%).
The ADA Survey Center conducted the survey on behalf of the Council on Access, Prevention, and Interprofessional Relations in response to a resolution that called for initiatives related to the oral health of vulnerable elders, according to an ADA news article.
"As we learn more about the oral-systemic relationship of disease, and as our population ages, we as a council are increasingly concerned about the quality of life faced by those elderly who have dental needs and little or no ability to have them addressed," stated Jerald Boseman, D.D.S., a council member from Salt Lake City, in the article.
Other results from the survey include:
• In 2007, more than 92% of all dentists provided care to the vulnerable elderly -- patients who are over age 65 and have limited mobility, limited resources, or complex health status.
• More than 24% required dentists to consult with dental specialists, and more than 37% required dentists to consult with physicians.
• More than 68% of dentists said that they needed more information on managing patients with complex medical histories, managing xerostomia (63.6%), and managing dementia patients (49.1%).
• Some of the major barriers to care reported by the dentists included inability to pay for services (88.7%), lack of transportation to dentist's office (68.4%), inadequate financial support for care from local, state, and/or federal programs (65.5%).
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